REGIONAL — COVID-19 may have slipped from the front pages and faded from daily conversation, but the virus has never left. It continues to circulate, and health experts are again seeing signs of increased activity heading into late summer, including here in Minnesota.
“I’m not sure I’d go as far to say that it’s a surge quite yet, but there is certainly an uptick in activity across the country,” said Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, speaking on a recent CIDRAP podcast. “Wastewater concentrations are increased in every region, but still moderate in the south and west, and low in the Midwest and Northeast.”
For now, Minnesota remains in the lower tier, but local data show a clear upward shift. According to the Minnesota Wastewater Surveillance Project, viral load in wastewater has increased by 181 percent in northeastern Minnesota since mid-June, echoing the same summertime trend seen in previous years of the pandemic. Statewide levels are still considered historically low, but the recent climb is a signal that those with underlying health conditions should be especially mindful.
Osterholm noted that the situation can change quickly. Six states, including California and Florida, are already seeing high wastewater viral concentrations, and five others, including Texas and Nevada, are considered very high.
Meanwhile, emergency rooms are seeing more children showing up with COVID symptoms.
“Emergency department visits are still considered low but continue to increase, especially in children in the 0 to 11 age group whose percentage of ED visits with a COVID-19 diagnosis is more than double the percentage of any other age group,” Osterholm said.
Deaths nationwide have held steady, ranging between 158 and 179 a week for more than a month, with 167 reported the week of July 19.
Osterholm emphasized that infections do not currently appear to be leading to the severe illness that marked previous surges.
“I expect activity to increase, but so far signs are not pointing to a huge surge, particularly in severe illness,” he said. “We are seeing a number of infections in the community, but only rarely are we seeing severe illness. Now could that change? Absolutely. But this is still good news.”
Vaccine confusion
The question of how to respond to new activity has been complicated by shifting and sometimes contradictory vaccine policies. Osterholm said uncertainty is leaving both the public and physicians guessing.
“Now we’re in a world of confusion,” Osterholm said. “What vaccines will be available? Which ones can be given based on consultation with your physician, what’s available, what’s not? Who will pay for what? It is such a mess. And it doesn’t have to be. It wasn’t before and now it is.”
He suggested the confusion may even be intentional.
“This, I believe, is an actual effort being made by HHS to do that,” he said. “Because by creating confusion, something as simple as why is a vaccine not being recommended or it is, is because it doesn’t work. It’s not safe. Is it because the public doesn’t like it? I mean, what’s the reason?”
Osterholm said evidence collected by CIDRAP’s Vaccine Integrity Project still strongly supports COVID-19 vaccination.
“We have demonstrated clearly in our own efforts here that the data of the past two years only continues to support the recommendations that were in place before this new administration came in,” he said.
Children left out
One of the more contentious issues is the status of vaccines for children. Reports suggest the Food and Drug Administration may not renew Pfizer’s emergency authorization for children under age 5.
“If this emergency use authorization or EUA is pulled, healthy children under five will not have an option for vaccination,” Osterholm said. “Even if the FDA renewed the Pfizer EUA for healthy children, the ACIP has made their position clear that they do not plan to recommend vaccines to healthy children regardless.”
That represents a major change from last year, when both Pfizer and Moderna had approval or authorization down to six months of age. More recent approvals have narrowed eligibility to those with at least one immunocompromised condition or older adults.
“We expect that anyone over the age of 65 and for those six months and older with at least one immunocompromised condition, will be able to get a COVID vaccine,” Osterholm said. “So, if you’re healthy and under 65, your options may be very limited.”
The American Academy of Pediatrics has pushed back, recommending at least two doses for all children six months and older. Osterholm praised the AAP’s stance, saying it is “based on good science” and focused on public health.